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J Am Acad Orthop Surg, Vol 17, No 3, March 2009, 137-151.
© 2009 the American Academy of Orthopaedic Surgeons
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Terrible Triad Injury of the Elbow: Current Concepts

Paul K. Mathew, MD, FRCSC, George S. Athwal, MD, FRCSC and Graham J. W. King, MD, MSc, FRCSC

Dr. Mathew is Clinical Fellow, Hand and Upper Limb Centre, St. Joseph’s Health Care, University of Western Ontario, London, Ontario, Canada. Dr. Athwal is Assistant Professor of Surgery and Consultant Shoulder and Elbow Surgeon, Hand and Upper Limb Centre, St. Joseph’s Health Care, University of Western Ontario. Dr. King is Professor of Surgery and Consultant, Hand and Upper Limb Centre, St. Joseph’s Health Care, University of Western Ontario.

Dr. Athwal or a member of his immediate family has received research or institutional support from Wright Medical Technologies. Dr. King or a member of his immediate family is affiliated with the publication Journal of Hand Surgery (American); has received royalties from Tornier, Wright Medical Technology, and Tenet Medical; and is a member of a speakers’ bureau or has made paid presentations on behalf of and received research or institutional support from Wright Medical Technology. Neither Dr. Mathew nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Paul K. Mathew, MD, FRCSC, et al

Reprint requests: Dr. Athwal, Hand and Upper Limb Centre, St. Joseph’s Health Care, 268 Grosvenor Street, London, Ontario, Canada N6A 4L6.

Fracture-dislocations of the elbow remain among the most difficult injuries to manage. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. The primary goal of surgical fixation is to stabilize the elbow to permit early motion. Recent literature has improved our understanding of elbow anatomy and biomechanics along with the pathoanatomy of this injury, thereby allowing the development of a systematic approach for treatment and rehabilitation. Advances in knowledge combined with improved implants and surgical techniques have contributed to better outcomes.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.